| NPI | 1124841986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARRETT SCOTT FONG President 626-286-7151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2024-11-01 |