| NPI | 1386924694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KETAN ARUN SUKKAWALA President 979-694-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 19635) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-06-11 |