| NPI | 1396949541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY SIDERMAN President 323-585-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2007-08-10 |