| NPI | 1437617115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA FERMIN Practice Manager 551-900-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2019-06-11 |