| NPI | 1013035153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES DOUGLAS FOWLER President 951-686-5301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 19067) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-08-22 |