| NPI | 1629420666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENDALY FERNANDEZ Owner/Provider 940-696-9701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31663) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2016-07-01 |