| NPI | 1386313997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVE GOLDWYN JEQUINTO Owner/Doctor 210-944-0504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223G0001X Dentist General Practice | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2021-11-16 |