NPI age
20 years
Enumerated 2006-03-03
Across 15661 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 752053696 | TAX ID |
| 05 (TX) | 0084154-01 | |
| 01 (TX) | 025963 | AETNA 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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