| NPI | 1730676735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN HUMPHRIES Director Of Operations 972-200-1190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 29699) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2018-04-16 |