| NPI | 1124745740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN GUILLERMO LOPEZ Owner 239-768-1011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2022-10-24 |