| NPI | 1689911471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BOLTEN General Dentist/Owner 972-562-7999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 21014) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25399) |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2016-05-20 |