| NPI | 1992985865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABRINA LAYEL Assistant Vice President, Finance 423-869-6229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| 1223P0300X Dentist Periodontics | |
| 1223E0200X Dentist Endodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223G0001X Dentist General Practice | |
| 1223X0008X Dentist Oral and Maxillofacial Radiology | |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2022-04-26 |