| NPI | 1356618383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELLY FOWLER Dentist/President 714-558-8077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 32436) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2020-05-22 |