| NPI | 1992053409 |
|---|---|
| Doing Business As | SOUTHFORK DENTAL |
| Entity Type | Organization |
| Authorized Contact | BINDU MADHAVI KOLLI President 214-693-8661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21085) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |