| NPI | 1619280781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL E BROUSSARD Owner 512-346-1221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 8751) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2011-08-11 |