| NPI | 1477692762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA JAQUEZ Office Manager 817-367-6453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21511) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2008-07-01 |