| NPI | 1396006714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA POTTER HUMPHREY THOMAS Manager 210-333-6911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25974) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2012-06-01 |