| NPI | 1457411258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD KENNY WILSON President 858-484-4880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 32157) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 32204) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 32204) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |