| NPI | 1639281264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Provider Relations 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-08-18 |