| NPI | 1295227288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RITA DERAGOBIAN Dentist/Owner 626-914-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: CA 55480) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2020-01-08 |