| NPI | 1992213987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA AGUILAR Director Of Revenue & Credentialing 817-466-8554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2021-03-04 |