| NPI | 1790326056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTOINETTE BROEDEL Credentialing Specialist 702-374-1616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2019-10-07 |