| NPI | 1245405877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA SUE NELSON Office COO Rdinator 760-438-0948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 28010) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2018-07-11 |