| NPI | 1922423078 |
|---|---|
| Doing Business As | MODERN FAMILY DENTAL HWY 1187 |
| Entity Type | Organization |
| Authorized Contact | ODALIS PATRICIA SKUR Doctor 817-297-0058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 20899) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2014-02-26 |