| NPI | 1467271569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN EDALATPAJOUH Vice President 310-529-7292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2024-10-07 |