| NPI | 1992890040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GALEN K. BREY President 251-460-2448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 3402) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |