| NPI | 1316556061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES VANDEBERG Owner 210-902-9122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2020-07-30 |