| NPI | 1609398411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES C. PARK President 972-423-6804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28207) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-07-21 |