| NPI | 1124889811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA AZUCENA CORTEZ Manager 240-773-1211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 261QP0905X Clinic/Center Public Health, State or Local |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2025-03-05 |