| NPI | 1043923337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENNETT JOE VACULIK Managing Partner 903-243-4790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-01-02 |
| Last Update Date | 2023-03-14 |