| NPI | 1063803054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRIANI ONGKORAHARDJO Owner 909-396-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 46120) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2016-09-14 |