| NPI | 1184919441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKS STEVENS Dentist 817-423-2223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 12595) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 23533) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2011-07-06 |