| NPI | 1376942672 |
|---|---|
| Doing Business As | GOLDEN SMILES DENTAL |
| Entity Type | Organization |
| Authorized Contact | ANKIN DERAGOBIAN Owner/President 909-481-8990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 59757) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2015-01-28 |