| NPI | 1639384456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERYL WALLACE Office Manager 210-493-6067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |