| NPI | 1124521075 |
|---|---|
| Former Legal Business Name | MIGUEL FUENTES |
| Entity Type | Organization |
| Authorized Contact | MIGUEL FUENTES Dentist 619-488-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: 597411) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-03-16 |