| NPI | 1790061505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURENA D MOORE Dentist 280-302-6284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 16297) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: TX 22996) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |