| NPI | 1588120729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREL MORENO Dentist 619-488-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2019-02-12 |