NPI age
19 years
Enumerated 2006-10-17
Across 63 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 00L740 | BC/BS # |
| 05 (TX) | 130586402 | |
| 05 (TX) | 130586404 | |
| 05 (TX) | 130586406 | |
| 01 (TX) | 751572652 | TAX ID# |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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