| NPI | 1053527002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE TANASSY Office Manager 818-991-8010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 224160) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 031691) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 41051) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2010-10-28 |