| NPI | 1295101640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIVIAN MONIQUE VALDEZ Dentist 909-591-9211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61102) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 61143) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |