| NPI | 1396344933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL WADE BENAGE Owner 903-445-2433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-10-24 |
| Last Update Date | 2020-10-24 |