| NPI | 1942550686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM M BOLAK Manager 972-612-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 17551) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: TX 17551) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2012-09-10 |