| NPI | 1326554122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN ALAN STEWART Member 469-338-9283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 31281) |
| Enumeration Date | 2017-12-17 |
| Last Update Date | 2017-12-17 |