NPI age
20 years
Enumerated 2005-08-04
Across 1797 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 170633501 | |
| 01 (TX) | 21237 | STATE LICENSE NUMBER |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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