| NPI | 1033596788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER ROBERTSON SUMARSONO Dentist 714-864-8261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 40736) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2015-05-01 |