| NPI | 1801301643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL CHRISTOPHER MACK Manager 903-236-4050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 13770) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 32168) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2017-12-01 |