| NPI | 1972066363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARISSA MAE CROSIER Administrative Assistant 615-849-1292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2019-04-11 |