| NPI | 1366821795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIMAL PATEL Managing Member/President 402-650-7405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27680) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 19056) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2015-05-18 |