| NPI | 1912187428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MATTHEW MIKULENCAK President 817-923-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 20876) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2008-04-07 |