| NPI | 1578066403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LIGHTFOOT Authorized Representative 214-702-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 11606) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2023-05-09 |