| NPI | 1447356639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA DEANNE GALLUP Dentist 903-872-3981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 18748) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 17139) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-22 |