| NPI | 1811464639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAUSTO NICIEZA President 954-985-3883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2018-10-30 |