| NPI | 1003262502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REENA KHULLAR Owner 909-996-0523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CA 49562) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2022-05-10 |