NPI age
20 years
Enumerated 2005-12-21
Across 64 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 0902165 | |
| 01 (TX) | 75-2277547 | FEDERAL TAX ID |
| 01 (TX) | K53H | BLUE CROSS BLUE SHIELD |
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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