| NPI | 1962153833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN HINCKLEY President/Owner 936-404-8731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-01-12 |