NPI age
11 years
Enumerated 2014-10-22
Across 9237 active dentist providers in Texas.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 1649465659 | PROVIDER NPI NUMBER |
| 01 (TX) | 23502 | DENTAL LICENSE NUMBER |
| 05 (TX) | 189843901 | |
| 01 (TX) | G0154523 | TEXAS DEPARTMENT OF PUBLIC SAFETY CONTROLLED SUBSTANCE NUMBER |
Multi-provider organization. 1 individual provider on file at this primary address.
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