| NPI | 1528194099 |
|---|---|
| Former Legal Business Name | NONE |
| Entity Type | Organization |
| Authorized Contact | THOMAS CLARK Owner 713-691-1831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 10960) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-08-22 |