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 |