| NPI | 1851143085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE CAROLINA CAMACHO Clinical Director 346-291-1119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2025-08-13 |