| NPI | 1659425759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYLE PAUL PETRUTSAS Owner Dentist 214-521-2258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 18774) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-04-08 |