| NPI | 1508572439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL H PARK Owner/President 310-901-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-01-24 |