| NPI | 1356911440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK TIEKEN Owner 281-222-9924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2021-06-30 |