| NPI | 1972001048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN GATLIN BROGDON Owner 817-923-4606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TX 17178) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-01-24 |