| NPI | 1699044784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA L. KERNS Doctor 254-399-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 17577) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 188559) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2011-12-20 |