| NPI | 1124428271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESIA LAKSMANA President 310-945-8382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 58149) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2014-08-26 |