NPI age
18 years
Enumerated 2007-12-03
Across 1797 active dentist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (LA) | 5873 | STATE LICENSE |
| 01 (TX) | 25216 | STATE LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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