| NPI | 1831464387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY K. CLARK Owner 972-291-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 18113) |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2012-03-16 |