| NPI | 1265841415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY BRUCE JACOBSEN Dds/President 626-445-8048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 26077) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |