| NPI | 1962040303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA ANN VASQUEZ Operations Manager 512-892-2273 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2023-05-31 |