| NPI | 1568875250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIEP PHAM Owner 979-245-2104 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 17862) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 12472) |
| 122300000X Dentist (Licence: TX 24866) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |