| NPI | 1427319763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAISY S IBRAHIM Owner 760-340-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 43447) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2015-06-22 |