| NPI | 1164506903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE ANN MCLENDON Office Manager 817-281-1764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 13611) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 12468) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2014-01-24 |