| NPI | 1922878941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LIGHTFOOT Authorized Official 214-702-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2025-01-16 |