| NPI | 1477806024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN T DANIELS Owner 817-271-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: DC 1000695) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MD 14023) |
| 261QD0000X Clinic/Center, Dental (Licence: VA 0401411980) | |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2012-10-19 |