| NPI | 1639990351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY GARCIA-ROCHA Sr Credentialing Team Lead 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2024-10-24 |