| NPI | 1245048875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA SOROUSHIAN Owner 949-413-4828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2024-12-30 |