| NPI | 1093058471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRENE THAMMASITHIBOON Owener 469-742-0793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25969) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2013-04-03 |