| NPI | 1659629319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL NITTINGER Manager, Credentialing 972-755-0816 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223G0001X Dentist, General Practice | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2017-11-17 |