| NPI | 1811513666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANELLE BEVILACQUA Managing Member 214-475-1523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 207L00000X Anesthesiology |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-17 |