| NPI | 1184798522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY C DO President 817-473-1560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 18686) |
| Enumeration Date | 2006-11-18 |
| Last Update Date | 2020-08-22 |