| NPI | 1417594946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LIGHTFOOT Authorized Representative 214-702-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2023-05-09 |