| NPI | 1699288068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GOODWIN Co Owner 972-816-3485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2018-03-17 |