| NPI | 1487174280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY J GONZALEZ Administrative Assistant 210-493-9944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-07-21 |