| NPI | 1417622432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA CAROLINA VILLARREAL Credentialing Manager 210-495-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2021-08-11 |