| NPI | 1124976501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA HERNANDEZ Rcm And Credentialing Manager 331-645-5299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2026-03-20 |
| Last Update Date | 2026-03-20 |