| NPI | 1225498421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WISSAM AYOUB Dentist 714-848-2277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 55496) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2020-09-09 |