| NPI | 1174222608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARIBORZ VENEGAS CEO/President 626-412-0200 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2023-02-23 |