| NPI | 1790053247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M TREVINO Pediatric Dentist 281-444-3999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 24983) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |