| NPI | 1649768979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE C MOORE Office Manager 972-966-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 16373) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2018-04-23 |