| NPI | 1326585274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISHNA COLLURU Owner 817-379-9091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24625) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 31537) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |