| NPI | 1124464813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTY MONTGOMERY Owner 512-420-8889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 24217) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2013-12-05 |