| NPI | 1396331435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DULCE Y DE JESUS Dentist 469-501-2640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QM2500X Clinic/Center, Medical Specialty | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2021-02-12 |