| NPI | 1336333780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH B WAUGH President Of Corporation 661-948-5061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 14900) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A22524) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |