| NPI | 1134580939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID MINNICH Owner 760-721-1552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 35432) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2016-03-08 |