| NPI | 1942623434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES STEVEN FORTENBERRY Dentist/Owner 713-774-9774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 13614) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2014-02-04 |