| NPI | 1154970366 |
|---|---|
| Doing Business As | IMPLANT & PERIODONTIC SPECIALISTS OF PUEBLO |
| Entity Type | Organization |
| Authorized Contact | MICHAEL ROBERT HERRERA Business Manager 760-978-8527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2020-11-12 |