| NPI | 1851655146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN M PAYNE President 817-498-3889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 20864) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2022-07-06 |