| NPI | 1669026555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY NELSON Owner 214-454-3816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2024-06-26 |