| NPI | 1417267451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M BANTA Owner/Dr 214-363-6415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 13059) |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2010-10-08 |