| NPI | 1427445709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELAINE FARIAS Owner 361-510-6796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 16422) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2015-04-24 |