| NPI | 1770193070 |
|---|---|
| Doing Business As | MAIN STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | JUSTIN DEXTER KOEN Partner 512-295-9925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2020-08-03 |