| NPI | 1518666049 |
|---|---|
| Doing Business As | CHILDRENS DENTAL FUNZONE |
| Entity Type | Organization |
| Authorized Contact | FAIRBORZ RODEF CEO/President 626-412-0200 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2024-04-08 |