| NPI | 1588740187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSON HARRELL Owner 281-937-1671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 20157) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 19758) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-08-22 |