| NPI | 1053139519 |
|---|---|
| Doing Business As | NORTHSIDE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ERIKA MELISSA MENJIVAR Sr. Credentialing Specialist 469-596-6137 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2024-10-02 |
| Last Update Date | 2024-10-02 |