| NPI | 1750510020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE RENEE BOSTON Dentist/Owner 903-893-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2024-10-16 |