| NPI | 1144993502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY A SHIMADA Partner 310-792-8610 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223P0700X Dentist Prosthodontics | |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2021-07-30 |