| NPI | 1093523656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN EVANS Owner/Authorized Official 858-335-8892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2024-12-27 |
| Last Update Date | 2024-12-27 |