| NPI | 1396011839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY W NELSON Owner/President 210-675-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 20528) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2020-08-06 |