| NPI | 1255179636 |
|---|---|
| Doing Business As | SEA GLASS ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | SOPHIE LOGAN Orthodontist 831-331-1903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-07-18 |
| Last Update Date | 2024-07-18 |