| NPI | 1447880646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE VILLANUEVA Managing Member 469-585-0755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2025-04-02 |