| NPI | 1417027251 |
|---|---|
| Other Name | PROFESSIONAL ASSOCIATE |
| Entity Type | Organization |
| Authorized Contact | EUGENE DAVIS STEVENSON Owner 915-591-1999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 13513) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2009-10-01 |