| NPI | 1285762575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN R TATE Treasurer 817-295-7116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 13143) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2017-02-22 |