| NPI | 1598846180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER LEE PENDERGRASS Co Owner 806-358-8801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 19725) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 20879) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |