| NPI | 1669751434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAISA IDRISS Dentist 281-257-8815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 17900) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2011-08-11 |