| NPI | 1821261157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESMERALDA MORALES Office Manager 817-577-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 20467) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-04-08 |