| NPI | 1225457328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY DOUGLAS KRUEGER Maxillofacial Prosthodontist 760-479-0961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 42347) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-04-16 |