| NPI | 1720690100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH ANDREW SONNEVELD Single Member/Owner 817-927-1818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2020-08-18 |