| NPI | 1902954472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI WILLIS Administrative Asst. 972-644-1162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 19484) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 10924) |
| 1223E0200X Dentist, Endodontics (Licence: TX 16886) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2016-01-25 |