| NPI | 1194111815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL SYLVESTER GONZALES President 512-501-4020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22311) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: TX 22311) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2015-05-21 |