| NPI | 1619459161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA JACKSON Office Manager 832-361-3222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2018-08-31 |