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 |