| NPI | 1891536546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA CAROLINA VILLARREAL Operations/Credentialing Manager 210-495-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2024-06-11 |