| NPI | 1083089270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY ENDERLE Practice Director 830-980-8099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |