| NPI | 1265624985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANOKNUCH SHIFLETT President 626-480-1543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 40303) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2022-07-21 |