| NPI | 1730369299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVELLE FORD President/Owner 254-699-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 17564) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2012-06-22 |