| NPI | 1164801544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY MAGRUDER Owner 409-762-4522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25665) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 11659) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2015-05-19 |