| NPI | 1891271557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER CROSS Owner 817-240-2543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 30809) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30809) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2018-07-16 |