| NPI | 1295976082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEJI V. FASHEMO Member 361-985-0964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 21639) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2009-03-09 |