| NPI | 1972376143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER WILLIAMS Credentialing Manager 806-353-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2023-10-31 |