| NPI | 1053475624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE A JOHNSTON Dentist 806-797-6453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 11088) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2019-04-17 |