| NPI | 1992976997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA R. FORTNER Administrative Assisstant 901-398-0793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |