| NPI | 1093843179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON ALBERT BERRY Dentist 817-326-4098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 19354) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 19777) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |