| NPI | 1114206828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGRID MACK CRUZ Dentist 909-947-0670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 53243) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2016-04-20 |