| NPI | 1992853337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL L. JOHNSON CEO 251-639-0911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 4049) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 5453C) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2016-02-17 |