| NPI | 1144462458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERI FAGO CROS Dentist 760-444-3202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 56314) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58148) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2012-03-16 |