| NPI | 1033567441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAURICIO DOSSANTOS Owner Dentist 909-709-6766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61711) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2016-05-26 |