| NPI | 1285287631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA ZAK CEO, Dentist 310-503-9277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 1223P0106X Dentist Oral and Maxillofacial Pathology | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223E0200X Dentist Endodontics | |
| 1223P0300X Dentist Periodontics | |
| 1223P0700X Dentist Prosthodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2021-10-29 |