| NPI | 1578148201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSAMA SIDDIQUI Owner 469-781-0231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2023-11-15 |