| NPI | 1760621106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAENIE OAKES ROBERTS Co Director 214-728-9419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22822) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 21466) |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2009-02-09 |