| NPI | 1952661308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSYEH ANGELA TAVAKKOLI Owner 832-877-0962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24041) |
| Enumeration Date | 2012-05-19 |
| Last Update Date | 2012-05-19 |