| NPI | 1093198186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTTO L. HEROD Dentist/Owner 210-328-2013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22178) |
| 1223G0001X Dentist, General Practice (Licence: TX 25595) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |