| NPI | 1306391362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY L LASSITER Dentist 254-666-1366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 15519) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2016-08-19 |