| NPI | 1811042567 |
|---|---|
| Doing Business As | CENTROMED SOUTH PARK DENTAL |
| Entity Type | Organization |
| Authorized Contact | CHUCK WALZEL CFO 210-334-3724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: TX HBOCS00758-04-00) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX HBOCS00758-04-00) |
| 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: TX HBOCS00758-04-00) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2013-05-09 |