| NPI | 1972200509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN HERNANDEZ Owner 347-228-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-02-14 |