| NPI | 1184455743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE NGUYEN THAI Owner 469-360-1305 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-08-13 |