| NPI | 1467968479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MCCULLOUGH DEKOCH Manager 210-824-3243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24684) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2017-12-28 |