Individual
KONGYAN DREW NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
317 S MARKET ST, GOLIAD, TX 77963-4167
(361) 645-2381
Mailing address
317 S MARKET ST, P.O. BOX 1480, GOLIAD, TX 77963-4167
(361) 645-2381
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
31979
TX
Other
Enumeration date
07/12/2016
Last updated
07/12/2016
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