| NPI | 1265710826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEAU MCKENZIE SOARES President 714-974-5906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CA 56076) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2011-08-01 |