| NPI | 1053791301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN JO DELANEY Dentist 817-937-1764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: ME DEN4422) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2015-06-02 |