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 |