| NPI | 1497054712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILL PARKS Owner 903-526-7977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 17107) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2011-03-25 |