| NPI | 1316564990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA N AGUILAR Director Of Revenue & Credentialing 817-466-8554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2021-03-04 |