| NPI | 1164707972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE J JOHNSON President/Owner 512-452-2195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 17654) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2011-10-13 |