| NPI | 1871126284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVERETT CHAD EVANS Owner/Dentist 940-312-5626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2022-12-01 |