| NPI | 1467694208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DERAE SHEPPARD President 817-477-0922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 21182) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2009-03-25 |