| NPI | 1881951333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BURTON FERGUSON Managing Member 210-675-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24904) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 24904) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2012-04-20 |