| NPI | 1922285493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA HUNTER Biller 915-201-9917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 20501) |
| 1223G0001X Dentist General Practice (Licence: TX 21113) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2021-02-12 |