| NPI | 1184127920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE JORDAN Provider/Owner 832-840-8043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27587) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-04-26 |