| NPI | 1427691583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY GOGGANS CFO 254-727-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2022-05-04 |