| NPI | 1982292918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE THACKER Owner 205-798-6096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-01-05 |