| NPI | 1700166162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY S KUBO Dentist/Owner 817-571-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2011-08-17 |