| NPI | 1316716129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH B ILUSTRE President 832-863-2702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality | |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2023-12-21 |