| NPI | 1003168675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANABELLE M MUDAFORT President 787-565-0134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PR 2787) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PR 2808) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2012-10-08 |