| NPI | 1114513256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DULCE Y DE JESUS Dentist 469-501-2640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223X2210X Dentist, Orofacial Pain | |
| 261QD0000X Clinic/Center, Dental | |
| 261QE0002X Clinic/Center, Emergency Care | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2021-02-12 |