| NPI | 1174192900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIANA GARCIA Credentialing Specialist 972-932-3918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2021-07-07 |