| NPI | 1235506312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMMANUEL BERNARD GROSS Owner 310-451-5748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 39266) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 59919) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 31742) | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2015-08-25 |