| NPI | 1679194575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZAN V HARRIS Owner 254-630-1456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2020-11-13 |