| NPI | 1508875147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE MARIE ASHTON Managed Care Coordinator 512-454-1220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2010-01-14 |