| NPI | 1063015576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT TAE CEO 424-392-2715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2023-04-23 |