| NPI | 1124598917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAYTON CARSNER VP/COO 512-324-5846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2019-07-22 |