| NPI | 1922514199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRIE BRACE GREEN Dentist/ Partner Owner 915-217-8763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AL D6202) |
| Enumeration Date | 2017-12-23 |
| Last Update Date | 2017-12-23 |