NPI | 1124738422 |
---|---|
Doing Business As | LANDIS AVENUE DENTAL SERVICES |
Entity Type | Organization |
Authorized Contact | RICARDO ROMAN Chief Financial Officer 619-515-2300 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Enumeration Date | 2022-11-29 |
Last Update Date | 2024-02-20 |