| NPI | 1023457785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES I BALLOU Manager 469-888-4453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 25102) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2013-06-17 |