| NPI | 1568770162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL K MARTIN Credentialing Specialist 254-216-0661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 10278) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CO 10196) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2021-04-19 |