| NPI | 1073904439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE VANBENSCHOTEN Manager 870-834-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 29562) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2015-02-06 |