| NPI | 1487832945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANIEL JEFFERSON Owner 281-895-7787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2008-02-07 |