| NPI | 1174093256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Credentialing Supervisor 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2019-03-31 |