| NPI | 1770929887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMMED MANSOUR Owner 469-230-7338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24193) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |