| NPI | 1821407040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERT VASUT Owner/Provider 512-258-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22107) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2014-08-13 |