| NPI | 1730331778 |
|---|---|
| Doing Business As | SOUTHLAKE ENDODONTICS |
| Entity Type | Organization |
| Authorized Contact | CHARLES MICHAEL LARSEN Member 817-488-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2008-10-22 |