| NPI | 1174018568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN COUGHLIN Owner 323-898-3102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 28587) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 28586) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-06-13 |