| NPI | 1508870866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK FAGIN President 949-554-4434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 52161) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2022-07-21 |