| NPI | 1154582666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS M. GISTARO Owner Operator 619-426-6891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 029282) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2008-06-18 |