| NPI | 1295890994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE POLEY MORAN President 949-338-7103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CA 48514) |
| Enumeration Date | 2006-12-25 |
| Last Update Date | 2011-02-11 |