| NPI | 1700625704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KACIE MARIE CULOTTA Owner 512-900-9715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2025-05-25 |