| NPI | 1437874211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANDREWS Manager 979-307-7696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2022-11-19 |