NPI age
19 years
Enumerated 2006-12-11
Across 1797 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 609422190A | |
| 01 (GA) | 100201 | AVESIS MEDICAID |
| 01 (GA) | 9181147 | DORAL MEDICAID |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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