| NPI | 1396043576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA GABRIELA MOGOLLON Owner 786-597-1636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN20484) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2018-07-02 |