NPI | 1417170655 |
---|---|
Entity Type | Organization |
Authorized Contact | HOLLY MARIE PORTWOOD Chief Operating Officer 817-920-6936 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
Enumeration Date | 2007-04-10 |
Last Update Date | 2024-07-08 |