| NPI | 1265204622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SELINDA GONZALEZ Office Manager 210-888-0700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2024-05-20 |