| NPI | 1881807592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RCHARD FOSSUM Organizer 254-778-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22304) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |