| NPI | 1255842159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN CALLIA Shareholder 512-990-8550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 20343) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2017-10-18 |