| NPI | 1750255188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LIGHTFOOT Director, Payer Relations 214-702-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-09-30 |
| Last Update Date | 2026-01-28 |