| NPI | 1174188510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTANY BRUNNER Office Manager 909-481-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2019-05-01 |