| NPI | 1902278484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONAL WAYNE ANDRESS Owner 281-738-1579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 6626) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 6626) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2015-10-23 |