| NPI | 1942385778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL NITTINGER Manager Credentialing 972-755-0816 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| 1223P0300X Dentist Periodontics | |
| 1223P0700X Dentist Prosthodontics | |
| 122300000X Dentist | |
| 1223E0200X Dentist Endodontics | |
| 1223P0221X Dentist Pediatric Dentistry | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2018-03-20 |