| NPI | 1861910705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA MARIE BROWN Director 817-440-6060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN d104717) |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2017-08-30 |