| NPI | 1063957991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK STEWART BURCHFIELD Owner/Dentist 979-846-7799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 23796) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22821) |
| Enumeration Date | 2017-01-02 |
| Last Update Date | 2022-06-30 |