| NPI | 1942562756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS CAMPBELL BOURLAND Owner 214-564-5597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22690) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2012-06-08 |