| NPI | 1255579793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAY DERAKSHAN Dentist 858-485-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 46044) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2021-10-22 |