| NPI | 1104254374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIC HALAJIAN President 818-416-4776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA 56717) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 58380) |
| 1223P0300X Dentist Periodontics (Licence: CA 30624) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 55829) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 57793) | |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2013-10-24 |