| NPI | 1861052375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODOLFO CARBALLO Owner 305-444-8591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| 124Q00000X Dental Hygienist | |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-06-17 |