| NPI | 1023612918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN COUGHLIN Owner 323-898-3102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2020-11-23 |