| NPI | 1619277894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN SCOTT BLACK President 979-695-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 25509) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2014-04-03 |