| NPI | 1033660725 |
|---|---|
| Doing Business As | WEST AVENUE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | KATHLEEN B FONSECA Chief Operating Officer 210-877-2273 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |