| NPI | 1972711794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE HA LUONG Regional Manager 817-457-4141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 18994) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-08-17 |