| NPI | 1053743591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES STEWART Orthodontist 817-557-0025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 17519) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 11736) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2013-11-04 |