| NPI | 1417407677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH J. BRUST Dentist 760-244-7232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 43905) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2016-10-11 |