| NPI | 1699949925 |
|---|---|
| Former Legal Business Name | NO |
| Entity Type | Organization |
| Authorized Contact | BRENDA D DONATO President 1787-880-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2023-09-06 |