| NPI | 1104139773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ORLANDO JUAN LUCERO Dentist/Owner 179-599-5980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 80) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 7290) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2010-07-23 |