| NPI | 1023123569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY L HENRICHSEN Office Manager 972-530-7979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22043) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22745) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-08-22 |