| NPI | 1265708705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE A TREVINO Dentist 210-921-2288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 17643) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 17658) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-03-29 |