| NPI | 1861783557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL KIES Owner 512-445-5866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 11098) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21186) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 7037) | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2011-04-28 |