| NPI | 1275117491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN SB PARK Owner Dentist 213-220-4856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2023-07-13 |