| 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 |