NPI age
19 years
Enumerated 2006-12-12
Across 935 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 202376140 | TAX ID |
| 05 (TX) | 175391501 | |
| 05 (TX) | 175392302 | |
| 01 (TX) | 18386 | LICENSE |
| 01 (TX) | B18386 | CHIP |
Solo or small practice. No other active providers share this practice address in NPPES.
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