| NPI | 1740567817 |
|---|---|
| Doing Business As | 1223X0400X |
| Entity Type | Organization |
| Authorized Contact | ROSIE P CORRALES Office Manager 520-290-8787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2011-11-03 |