| NPI | 1376187336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER SMITH Orthodontist 267-250-5387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-11-03 |
| Last Update Date | 2019-11-03 |