| NPI | 1356550222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES B SEGULYEV President 818-846-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 48993) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 48514) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |