| NPI | 1013596964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK BLANK President 949-302-5146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |