| NPI | 1558925438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRISCILLA JEAN PORRAS General Manager 915-471-4700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2019-04-26 |