| NPI | 1134173552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JOSEPH JACOBS Owner Dentist 310-657-0411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 34349) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2020-08-22 |