| NPI | 1164430401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMPBELL RIDDICK JANSE Owner 210-523-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 13898) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2009-04-15 |