| NPI | 1063786705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PETTIT KETCHEL Pediatric Dentist 817-465-0044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 20274) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2013-06-18 |