| NPI | 1790417111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS PRESTON Office Credentialing Specialist 713-291-3474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2022-06-24 |