NPI age
19 years
Enumerated 2006-10-31
Across 9237 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 1111874 | |
| 01 (TX) | G60196-02 | CHIP |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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