| NPI | 1770901001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVEN GONZALEZ Director/Dentist 915-201-2539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25489) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2021-05-26 |