| NPI | 1417694845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICENTA REYES Lead Of Credentialing 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2023-05-02 |