| NPI | 1790778314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM J STARCK President 817-431-9566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: TX 17519) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2020-08-22 |