| NPI | 1588909956 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | RONALD JENARD MOON President/Dentist 712-777-6453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 19552) |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2012-12-11 |