| NPI | 1366371296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES ROBERT VANDEBERG Manager 210-902-9122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2026-05-18 |
| Last Update Date | 2026-05-18 |