| NPI | 1669563243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE CREDEUR Account Manager 281-837-9122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 18921) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-08-22 |