| NPI | 1265809065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE LUIS GERONIMO Dentist 714-267-6400 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 47897) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2020-01-03 |