| NPI | 1760106967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZEL GONZALEZ Billing Director 772-812-4903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 1223P0300X Dentist Periodontics | |
| Enumeration Date | 2022-09-30 |
| Last Update Date | 2022-09-30 |