| NPI | 1003216250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA CASU Credentialing Manager 713-790-6477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 30729) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2018-08-08 |