| NPI | 1376921528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN COUGHLIN Owner 323-898-3102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2017-02-20 |