| NPI | 1053649053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANG HO SHIN President 682-554-5969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 23002) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23002) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2009-12-02 |