| NPI | 1376299909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM ROBERT JENNINGS Owner 940-206-8956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2024-02-14 |