| NPI | 1811255029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KA-RON YVONNE WADE Owner 713-654-7756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 19435) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: TX 27647) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2012-04-25 |