| NPI | 1528442571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE ARTHUR AIVAZIAN Secretary 562-869-1686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 38036) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 49495) |
| 1223G0001X Dentist, General Practice (Licence: CA 41887) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 42015) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 59210) | |
| 1223P0300X Dentist, Periodontics (Licence: CA 44077) | |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2015-07-20 |