| NPI | 1013465582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL F NELSON Vice President 409-751-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2025-01-23 |