| NPI | 1982474573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HUNG LUONG CEO 267-357-7119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 122300000X Dentist | |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2024-01-04 |