| NPI | 1104203611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK WILSON STEFFENS Owner/Dentist 254-644-2463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 23907) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |