| NPI | 1598401598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESTINA OLIVARES Business Operations Manager 512-731-3895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2023-06-29 |