| NPI | 1649517376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BURTON FERGUSON Managing Member 210-683-6353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: 24904) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2013-01-15 |