| NPI | 1013294792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY RANDALL EVANS Owner 903-454-0918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 11800) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21548) |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2011-11-09 |