| NPI | 1205168473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY MELLARD President 210-687-1133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 13920) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 13919) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2010-02-12 |