| NPI | 1326315136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE K CLEVELAND Owner/President 940-455-7004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 21699) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2011-11-22 |