| NPI | 1699155507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IDA FERONTI Business Manager 817-292-3605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 21107) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23154) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2015-07-15 |