| NPI | 1558791566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES RICHARD PAYERLE President 817-568-6811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: TX 23735) |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2013-11-13 |