| NPI | 1225128143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANTON F WAGGONER President 210-490-7772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 15377) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-08-28 |