| NPI | 1447682547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN CANTRELL Member 972-442-9139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: TX 28065) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: TX 23948) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2013-07-31 |