| NPI | 1619807526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER BRIANNA BEAL Chief Operations Officer 325-212-4793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2026-05-21 |
| Last Update Date | 2026-05-21 |