| NPI | 1467842823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA HANNA Associate Dentist 310-780-0106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2015-01-23 |