| NPI | 1710126768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK NEAGLE Registered Agent 936-539-2980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: TX 22205) |
| Enumeration Date | 2009-02-16 |
| Last Update Date | 2009-04-21 |