| NPI | 1952059644 |
|---|---|
| Doing Business As | OFF THE TRACE DENTAL |
| Entity Type | Organization |
| Authorized Contact | PAMELA PONCE DE LEON DAIGLE Owner/Manager 985-326-1711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-03-12 |
| Last Update Date | 2022-03-12 |