| NPI | 1154050011 |
|---|---|
| Doing Business As | SAN ANTONIO ORTHODONTIC GROUP |
| Entity Type | Organization |
| Authorized Contact | GREGORY KOSTELAC Data Analyst 719-266-2717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2022-07-07 |