| NPI | 1699182618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL MARSHALL BRADY Owner 281-703-4115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 15127) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: TX 15127) |
| 122300000X Dentist (Licence: TX 15127) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 15127) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2014-07-22 |