NPI age
17 years
Enumerated 2008-09-30
Across 1797 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (CA) | 53689 | STATE LICENSE |
| 01 (TX) | 22107 | STATE LICENSE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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