| NPI | 1164074829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYN LUERA Owner 915-594-4048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2024-06-13 |