| NPI | 1841846458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMIT PATEL Officer 267-444-6396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QS0112X Clinic/Center Oral and Maxillofacial Surgery | |
| Enumeration Date | 2019-08-11 |
| Last Update Date | 2019-08-11 |