| NPI | 1225910607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA HERNANDEZ Rcm Credentialing Manager 331-645-5299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-07-24 |
| Last Update Date | 2026-05-12 |