| NPI | 1639828007 |
|---|---|
| Doing Business As | CLUBHOUSE PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | VICENTA REYES Credntialing ,Lead 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-03-22 |