| NPI | 1417006065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANN SHY Practice Administrator 210-614-3915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2016-04-25 |