| NPI | 1114220647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA AMANDA President 866-371-5205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25146) |
| Enumeration Date | 2010-12-05 |
| Last Update Date | 2011-02-03 |