| NPI | 1114700747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANA C PORRAS Manager/Owner 281-940-5315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2023-08-22 |