| NPI | 1396478277 |
|---|---|
| Former Legal Business Name | SAN ANTONIO ORTHODONTIC GROUP |
| Entity Type | Organization |
| Authorized Contact | GREGORY KOSTELAC Data Analyst 719-372-5605 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-07-07 |