| NPI | 1447583661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE WIDODO Dentist / Owner 626-444-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 46152) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2009-09-08 |