| NPI | 1831557370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN PHILLIPS Provider 979-299-6878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 16829) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-01-28 |