| NPI | 1295215168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANOKNUCH SHIFLETT CEO 626-991-3544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 40303) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2019-06-11 |