| NPI | 1811162621 |
|---|---|
| Doing Business As | SOUTHFORK DENTAL |
| Entity Type | Organization |
| Authorized Contact | BINDU M KOLLI President 972-424-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 21085) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2008-04-23 |