| NPI | 1306249933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE SCRUGGS MAYER Executive Director 409-359-5253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24756) |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2014-09-26 |