| NPI | 1588143762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM MICHAEL BOLAK Sole Member 972-964-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 17551) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-08-09 |