| NPI | 1598000325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE JOHNSON Office Manager 972-442-3028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 19412) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24605) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2012-12-05 |