| NPI | 1215266093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNE HANSEN BAYLESS Owner 325-673-8164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 12014) |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2012-06-01 |