| NPI | 1366812646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY BOZEMAN Office Manager 661-832-5530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 47411) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2016-12-08 |