| NPI | 1124547310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE TONG Dentist 949-387-6418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 33186) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CA 45069) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2022-07-21 |