| NPI | 1154588895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY R CROCKETT Owner 562-861-0496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 20092) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 50687) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |