| NPI | 1376630525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE LARRY REEVES President Secretary Treasurer 817-444-3890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 20177) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2020-08-22 |