| NPI | 1235272246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE L TILUS Office Manager 760-361-8056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 032959) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-08-22 |