| NPI | 1306539630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA REYES Billing Administrator 213-484-2625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2023-06-01 |