| NPI | 1497531388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANELLE WALTON Owner 512-953-8362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2023-10-06 |