| NPI | 1114039666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAGGIE VASQUEZ Regional Manager 305-821-2611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |