| NPI | 1316313893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATHAGAT CHAWALA Owner 972-516-1818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 24720) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 261Q00000X Clinic/Center | |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2024-07-16 |