| NPI | 1417756818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE BOLLINGER Rcm 512-500-0302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-03-10 |