| NPI | 1174014161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATISHA PEOPLES Onboarding And Credentialing 817-440-6060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2018-05-24 |