| NPI | 1083847792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN ADDLESON Business Administrator 619-291-4325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 20494) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 40060) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2009-08-27 |