| NPI | 1063537538 |
|---|---|
| Other Name | WIJAYA SULAEMAN, D.D.S. |
| Entity Type | Organization |
| Authorized Contact | AUDREY INDHIRA SULAEMAN Dentist 909-889-9591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 37166) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |