| NPI | 1124681564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LANE KENDALL Dentist 903-758-5551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2020-06-11 |