| NPI | 1376963876 |
|---|---|
| Doing Business As | MYDENTIST-LEWISVILLE |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing COO Rdinator 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |