| NPI | 1770712804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA R PEREZ Credentialer 512-788-4801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2009-07-10 |