| NPI | 1083138481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID O. MEDINA President 818-815-1229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CA 57425) |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2022-10-25 |