| NPI | 1417155417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE DEE ROACH Owner/Dentist 512-918-0005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 13219) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2007-07-11 |