| NPI | 1902011307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMY JOE MOON President 713-473-6677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 13206) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: TX 13002) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |