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 |