| NPI | 1073810735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORBET K ELLISON Owner 281-741-5247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 23589) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: TX 26246) |
| 1223G0001X Dentist General Practice (Licence: TX 21095) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: TX 23589) | |
| 1223P0300X Dentist Periodontics (Licence: TX 10216) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 23794) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 25662) | |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2011-11-17 |