| NPI | 1730553991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCO CUEVA Owner 214-636-2129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: TX 21478) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 21478) |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2015-11-25 |