| NPI | 1831472810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BOLTEN Owner/Partner 972-547-0554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 1223G0001X Dentist, General Practice (Licence: TX 21014) | |
| 1223G0001X Dentist, General Practice (Licence: TX 21007) | |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2015-01-13 |