| NPI | 1447692439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN SEAN JANSSEN Owner 806-928-6355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24601) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2013-07-19 |