| NPI | 1730925157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN CHAN Co Owner 469-663-0098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2024-07-04 |
| Last Update Date | 2024-07-04 |