| NPI | 1124104336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA A JOHNSON Administrator 858-566-5050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 20326) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-08-22 |