| NPI | 1952906117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN WALKER Member 800-500-0493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-12-03 |
| Last Update Date | 2022-06-17 |