| NPI | 1659798155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD S. HANCOCK Member 936-564-7240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2014-03-21 |