| NPI | 1043692098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE QUINTERO Owner 664-381-0916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ZZ 7022293) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2015-06-26 |