| NPI | 1003367533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER WILSON Manager 432-682-0565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30926) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2023-03-21 |