| NPI | 1972278943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN LUKA Dentist 469-273-1376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2021-08-12 |