| NPI | 1962940254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL NITTINGER Credentialing Manager 972-755-0876 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 122300000X Dentist | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2018-03-20 |