| NPI | 1083145460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON CLARK DAMON Owner/President 806-584-7991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27147) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: TX 27147) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2017-03-27 |