| NPI | 1770952814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRI H PHAM Doctor 817-496-2343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24570) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2024-04-01 |