| NPI | 1255974325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILBERT D'ANDRIA CFO 254-727-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2019-10-22 |