| NPI | 1336912864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSA WOLFFORD Credentialing Specialist 210-568-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-13 |