| NPI | 1679277735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERENTHES FIELDS Credentialing Specialist 512-271-4001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |