| NPI | 1114338514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS MIGUEL COLLAZOS CEO 661-327-2155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 60923) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-05-19 |