| NPI | 1003050717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE FOSSUM Dentist/Owner 832-595-2266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22804) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2021-09-10 |