| NPI | 1932672854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDITH CONTRERAS Manager 806-803-9452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2019-01-03 |