| NPI | 1871118133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY R. TARDY Dds 817-453-8826 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2020-06-12 |