| NPI | 1467749895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA M SWANSON Member 512-259-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 19414) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 19826) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2011-07-06 |