| NPI | 1043566672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAVIN JACOB MILLER President 858-546-7667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 42367) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2012-08-01 |