| NPI | 1760497291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRO A. PAVELKA Owner/President 972-231-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 11521) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-09-15 |