| NPI | 1033859863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA ZAK President/CEO 310-805-5201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223G0001X Dentist General Practice | |
| 1223P0300X Dentist Periodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-03-30 |