| NPI | 1023408192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL WAYNE REDDELL Owner/Manager 806-701-5066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: TX 19405) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2015-01-28 |