| NPI | 1962888149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD A KOVACH Managing Member 817-441-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23925) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2017-03-03 |