| NPI | 1164294591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA GONZALEZ Office Manager 909-821-9854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-03-12 |