| NPI | 1982035697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA PENN Office Manager 251-345-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 5104) |
| Enumeration Date | 2013-12-05 |
| Last Update Date | 2013-12-05 |