| NPI | 1982255345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALCOLM SHABO Owner 423-488-7199 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2019-12-13 |