| NPI | 1073940011 |
|---|---|
| Doing Business As | FATE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | ANDY DAVONG President 972-804-5624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25750) |
| Enumeration Date | 2013-10-05 |
| Last Update Date | 2013-10-05 |