| NPI | 1376783845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE ENRIQUE AREVALO President/ Dentist 909-465-6861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CA 49453) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2009-02-24 |