| NPI | 1922574847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Credentialing Supervisor 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2021-10-18 |