| NPI | 1003983453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON ALFRED PRATT Owner President 979-776-8689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 10443) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2012-01-25 |