| NPI | 1669888160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDIA N KEROUAC Insurance Coordinator 210-804-1558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 16195) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27962) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2015-05-29 |