| NPI | 1053690529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY Q NGUYEN Manager 251-508-5507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27338) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27060) |
| 1223G0001X Dentist, General Practice (Licence: TX 27106) | |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2011-08-15 |