| NPI | 1942639570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL DWAYNE ANDERSON Business Manager 817-247-4720 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29141) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2013-11-04 |