| NPI | 1386897916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LOUIS REZNIK Partner 432-333-7105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 11123) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 23423) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 23067) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2011-11-02 |