| NPI | 1083849707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY ISRAEL RUDD Owner 817-473-6857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22486) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2009-05-26 |