| NPI | 1700078763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL NITTINGER Manager, Credentialing 972-755-0816 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223G0001X Dentist General Practice | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223P0300X Dentist Periodontics | |
| 1223P0700X Dentist Prosthodontics | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2017-11-17 |