| NPI | 1689062960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANIA F KHATIB Dentist 817-921-4646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 23286) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 21722) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2015-01-08 |