| NPI | 1003084229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL DUROSEAU Owner 951-204-3651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 48452) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 48452) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2015-10-26 |