| NPI | 1407158876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS ADAM THACKER Owner 619-449-6555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57184) |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2010-11-17 |