| NPI | 1790898179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE JOHNSTON Credentialing 512-447-6685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-08-11 |