| NPI | 1710289061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI BRENTLINGER BAUER Rdh/Office Manager 817-473-0291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 12539) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24538) |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2010-11-18 |