| NPI | 1164305421 |
|---|---|
| Doing Business As | TIDEWATER LASER PERIO & IMPLANTS |
| Entity Type | Organization |
| Authorized Contact | JENNY GARCIA-ROCHA Sr Credentialing Team Lead 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-07-25 |