| NPI | 1992083117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAYLOR LOGAN TUCKER President 334-875-0486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 5723) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2011-07-22 |