| NPI | 1982708020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE MICHAEL SHORT President 731-668-3411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN DS2421) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2020-08-22 |