| NPI | 1023126786 |
|---|---|
| Doing Business As | FUN DENTIST-SOUTH |
| Entity Type | Organization |
| Authorized Contact | CHARLES W MILLER Owner 817-478-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 9223) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 9178) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 12597) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-01-30 |