| NPI | 1699090100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON A ZIMMERMAN Owner 817-731-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 20465) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2022-11-02 |