| NPI | 1124990601 |
|---|---|
| Doing Business As | PROVIDE DENTAL- CHESTERFIELD |
| Entity Type | Organization |
| Authorized Contact | PHILIP SON Dentist 323-787-9397 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2025-09-23 |