| NPI | 1285645465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE TANG Dentist 909-879-1024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 41134) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 40810) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2010-12-13 |