| NPI | 1962091454 |
|---|---|
| Doing Business As | ISLAND PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | EBONIE MARIE GONZALES Credentialing Mnagaer 505-850-3769 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2021-01-11 |