| NPI | 1477287126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAL JERGENSEN Owner 951-693-9373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-07-10 |
| Last Update Date | 2022-07-10 |