| NPI | 1497472625 |
|---|---|
| Doing Business As | INTENTIONAL DERMATOLOGY AND HEALTH |
| Entity Type | Organization |
| Authorized Contact | AMANDA J WOLTHOFF Owner 817-985-7685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2023-11-19 |