| NPI | 1003254004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TUAN T LY CEO 760-745-0593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 052343) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 57169) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2013-06-12 |