NPI | 1497059166 |
---|---|
Entity Type | Organization |
Authorized Contact | SHANNON NISSEN Owner 949-830-4101 |
Organization Subpart ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 56349) |
Enumeration Date | 2011-01-10 |
Last Update Date | 2011-01-10 |