| NPI | 1053441667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | C FRED PIETSCH President 972-690-8617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 10340) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 10482) |
| 1223P0300X Dentist, Periodontics (Licence: TX 19473) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 12807) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |