| NPI | 1912316456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA RIVERS President 979-779-6146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23933) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2014-08-08 |