| NPI | 1609656628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA RONQUILLO Office Manager 786-390-5716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2025-02-18 |