| NPI | 1295020170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL AGUILAR Director 772-288-2345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2022-06-14 |