NPI age
20 years
Enumerated 2005-06-20
Across 935 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 | 760445216 | TAX ID |
| 01 (TX) | D17793 | BCBS ID |
| 01 (TX) | 17793 | STATE LICENSE |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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