| NPI | 1306138045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Credentialing Supervisor 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN5380) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2022-07-21 |