| NPI | 1649346263 |
|---|---|
| Former Legal Business Name | COMMERCE ST FAMILY DENTAL CENTER PC |
| Entity Type | Organization |
| Authorized Contact | ALFRED GWINN BRADFORD CEO President Chairman Of Board 210-225-4867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 08923) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-10-25 |