| NPI | 1124393822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Provider Relations Specialist 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2015-03-26 |