| NPI | 1922398189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Provider Relations Specialist 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 1223E0200X Dentist, Endodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2014-08-04 |