| NPI | 1134221880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY ROBERT JOHNSON Owner 818-981-4824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 29606) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-08-22 |