| NPI | 1801063151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES J PORTALES Owner 936-441-3363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 19018) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |