| NPI | 1053857367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERRILY M SANDFORD Owner / Dentist 512-263-8284 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 18565) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-01-12 |