| NPI | 1205019858 |
|---|---|
| Doing Business As | PARK AVENUE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SOEDHARSONO JUDO Owner 909-629-0201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 34127) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2007-12-06 |