| NPI | 1023596061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT LEE OUELLETTE Owner 210-494-2005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 29686) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |