| NPI | 1295810505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE SUTHERLAND Owner 562-421-3336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery (Licence: CA 43862) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 43862) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2019-12-03 |