| NPI | 1154542231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH E ABOUSSIE Owner 940-723-6677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 9648) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |