| NPI | 1396184693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BERNARD LUCZAK CEO 817-527-1590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 19398) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-06-19 |