| NPI | 1508088675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICE A WYNDHAMSMITH Office Manager 626-795-9328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA 46195) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CA 41122) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 49312) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 37519) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2015-10-15 |