| NPI | 1619398278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNA AYALA Managing Member 210-632-4560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 24255) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24255) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2013-12-30 |