| NPI | 1659722189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN THOMAS WOLPERT General Dentist 254-371-7787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NE 5863) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 06749) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2016-06-27 |