| NPI | 1659189850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANA LOPEZ Orthodontist 571-314-4655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2024-12-20 |