| NPI | 1164695938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM M HICKEY Owner 903-465-9555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 12451) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 9256) |
| 1223G0001X Dentist General Practice (Licence: TX 16058) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2008-04-11 |