| NPI | 1972033280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN TYLER CETTIE Owner 832-470-6344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO 00202110) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-07-21 |