| NPI | 1871950923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRIAM PERDOMO-WATTS Owner/Dentist 251-626-0092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 5105) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-01-20 |