| NPI | 1427398064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY BRANN Owner 956-581-2773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 11372) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: TX 20855) |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2013-02-19 |