| NPI | 1467865832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ENRIQUE CRUZ Owner 512-593-7970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: TX 29766) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: TX 27862) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 29766) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 27824) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2014-06-03 |