| NPI | 1184340622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIDNEY J FOWLER Owner 936-564-9401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2022-10-31 |