| NPI | 1265987598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON TROY BACON Owner 817-710-7443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24381) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2016-08-16 |