| NPI | 1053707265 |
|---|---|
| Former Legal Business Name | BEACH BRACES |
| Entity Type | Organization |
| Authorized Contact | PATRICIA PANUCCI Owner 310-379-0006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 51124) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2015-04-14 |