| NPI | 1063560514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK D COLVILLE Owner President 830-372-9811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 15902) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |