| NPI | 1073773511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAROLD AVILA President 765-282-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12009932A) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |