| NPI | 1083962104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NASIM NAGHIBI RAVARI Manager 915-759-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: TX 26272) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2012-08-21 |