| NPI | 1679627590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS G TELLO President 817-281-9141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 19305) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2012-02-07 |