| NPI | 1144002502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY GARCIA ROCHA Sr Credentialing Team Lead 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2023-10-19 |