| NPI | 1972911444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES R GREEN Owner 940-322-2252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX TX16192) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX TX10742) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2014-08-27 |