| NPI | 1013795236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY GARICA-ROCHA Sr Credentialing Team Lead 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-09-19 |