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 |