| NPI | 1528683810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA VIRAMONTES Practice Manager 915-200-2645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2022-07-08 |