| NPI | 1780937979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Provider Relations Specialist 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2014-08-04 |