| NPI | 1356152425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFREDO CAVAZOS LERMA Provider 619-272-9021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |