| NPI | 1316239619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIELA K SULLIVAN Chief Executive Officer 714-377-2628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2011-05-05 |