| NPI | 1669743498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYFUS J BROUSSARD Orthodontist 409-898-7847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 11407) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2012-01-25 |