NPI age
19 years
Enumerated 2006-08-12
Across 15661 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 75-2300597 | TAX ID # |
| 05 (TX) | 1350373-02 | |
| 01 (TX) | B15843-1 | TEXAS CHIPS # |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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