| NPI | 1184946337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODRIGO LORENZO URIBE Owner 912-764-5435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: GA 11060) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: GA 012756) |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2010-02-15 |