| NPI | 1104938745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Credentialing Manager 305-274-2499 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223E0200X Dentist Endodontics | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-03-23 |