| NPI | 1952946279 |
|---|---|
| Doing Business As | GRAND PRAIRIE MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | JEFFREY L ROBERTS Owner 469-701-2344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2022-04-13 |