| NPI | 1710531165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES VANDEBERG Dr/Business Owner 210-902-9122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2019-07-24 |