| NPI | 1972494680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY BOWMAN President 512-917-4178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-07-11 |
| Last Update Date | 2025-07-11 |