| NPI | 1881152577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH ALANSARI Clinical Director 551-225-1915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2019-06-11 |