| NPI | 1457502429 |
|---|---|
| Doing Business As | SOUTHLAKE FAMILY DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | TY D SHAFER Owner 817-416-2228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21301) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2008-10-08 |