| NPI | 1790210904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS YOUNGBLOOD Owner 432-553-3886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21206) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25993) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2017-04-25 |