| NPI | 1427125996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSIE B GREEN Financial Coordinator 972-312-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 19395) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 19424) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |