| NPI | 1215318183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEEPAK NANAMALA REDDY President/CEO 760-402-0529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62102) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2015-06-16 |