| NPI | 1821360983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MOREAU Front Office 512-341-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 19139) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 20619) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2012-02-06 |