| NPI | 1194122358 |
|---|---|
| Doing Business As | PRAIRIE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | LUDIVINA LUIS PAGATPATAN President 310-303-3988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 48162) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2014-12-03 |