| NPI | 1992245153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Credentialing Coordinator 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-03-06 |