| NPI | 1174038517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVAN DALLA President/Owner 646-427-6519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 63130) |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2017-12-07 |