| NPI | 1154194249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER WILLIAMS Credentialing Manager 806-353-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2023-11-01 |