NPI | 1972992162 |
---|---|
Entity Type | Organization |
Authorized Contact | KRYSTAL GILLIS Dds 660-995-6933 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2008016892) |
Enumeration Date | 2015-01-12 |
Last Update Date | 2015-01-12 |