| NPI | 1851894851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOK VILLANUEVA Director Of Operations 251-301-9690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2018-03-15 |