| NPI | 1417188699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE TERRYL BERGER President 940-566-1828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 19353) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2009-08-05 |