| NPI | 1366549545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY DAVID MINSKY Owner 323-564-2444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 31668) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 31668) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CA 31668) | |
| 1223P0300X Dentist Periodontics (Licence: CA 31668) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 31668) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 31668) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-09-23 |