| NPI | 1184342644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA PEREZ Dentist 866-364-6682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2023-03-14 |