| NPI | 1104130905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN CANTU Credentialing Specialist 512-744-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23148) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2010-08-04 |