| NPI | 1164125456 |
|---|---|
| Doing Business As | FOSSIL DENTAL |
| Entity Type | Organization |
| Authorized Contact | WALTER D THAMES Owner/Dentist 210-888-5832 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2023-03-24 |