NPI age
19 years
Enumerated 2006-08-16
Across 650 active dentist providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 161869601 | |
| 01 (TX) | G60212-01 | CHIP ID |
| 01 (TX) | 010389 | COMP BENEFITS FACILITY # |
| 01 (TX) | 88D371 | BLUE CROSS BLUE SHEILD ID |
| 01 (TX) | 1565571 | UNITED CONCORDIA ID |
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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