| NPI | 1538353479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD VAN CAMMACK President 409-384-8121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 20846) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2007-09-04 |