| NPI | 1417389032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES STEWART Orthodontist 817-370-0268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 19486) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 11736) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2013-11-08 |