| NPI | 1063875508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESUS FABIOLA GASTELUM GASTELUM Dentist 01152664-329-5224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ZZ 1787539) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2016-04-05 |