| NPI | 1972597300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA ANN JOHNSON Office Manager 931-528-5105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2008-01-10 |