| NPI | 1336348127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIS ELBERT MAXWELL Owner/Orthodontist 915-852-5111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: TX 11040) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2018-01-23 |