| NPI | 1417216078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIDA TAHMORESI Dentist/Owner 254-698-4698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 20011) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 20439) |
| 1223G0001X Dentist General Practice (Licence: TX 23966) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2012-05-16 |