| NPI | 1679223515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAIRISSA HOLLAND Operations Manager 512-739-6229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2022-03-24 |