| NPI | 1962040303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY CANTRELL Credentialing Speicialist 512-215-4350 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2026-04-07 |