| NPI | 1154653004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERTHA ELIZABETH RODRIGUEZ Regional Manager 210-354-4867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 15889) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2010-02-03 |