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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1316003155

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 903-628-5436  Fax: 903-628-9619

Contact information for business:
Tel: 903-628-5436  Fax: 903-628-9619

Registration Information:
NPI: 1316003155
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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