| NPI | 1902152721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA ANGELES FUENTES Manager 972-416-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 20674) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 20674) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-12-17 |