| NPI | 1063065472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BRIAN WALLACH Partner 903-216-9687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2023-06-28 |