| NPI | 1285842195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WAYNE GASSAWAY Owner 661-324-8055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 26402) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-10 |