| NPI | 1376800474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN COLLETTE President 210-685-4831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WA DE60273289) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2012-04-13 |