NPI | 1740557198 |
---|---|
Entity Type | Organization |
Authorized Contact | STEPHANIE GOMEZ Provider Relations Specialist 305-274-2499 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
Additional Taxonomies | 122300000X Dentist |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
Enumeration Date | 2011-11-29 |
Last Update Date | 2014-08-01 |