| NPI | 1942584040 |
|---|---|
| Doing Business As | AQUA DENTAL INGRAM |
| Entity Type | Organization |
| Authorized Contact | ANTONIO RIVERA Managing Member 972-677-7845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2011-10-06 |