| NPI | 1376990382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ADELE BOLLINGER Owner/President 949-759-7007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 26589) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2016-05-19 |