| NPI | 1003109612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN RICHARD WOLFSON Owner 818-998-6446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA D27858) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CA D28675) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2011-05-16 |