| NPI | 1154516680 |
|---|---|
| Other Name | STATE DENTAL INC. |
| Entity Type | Organization |
| Authorized Contact | LARISSA GUSHANSKY Owner 323-563-9124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2021-11-30 |