| NPI | 1013278779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNE HANSEN BAYLESS President 325-673-8164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 12014) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2012-05-30 |