| NPI | 1205563004 |
|---|---|
| Former Legal Business Name | INTERCOASTAL DENTAL PLLC |
| Entity Type | Organization |
| Authorized Contact | ALEXANDRE EIAN GAETA President 626-264-0182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2022-08-02 |