| NPI | 1386142602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY ROCHA Payer Enrollment Manager 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2025-08-15 |