| NPI | 1982940185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Provider Relations Specialist 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2014-08-01 |