| NPI | 1093861882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE ARTHUR AIVAZIAN Secretary 562-869-1686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 41887) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 42015) |
| 122300000X Dentist (Licence: CA 47500) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2015-06-01 |