| NPI | 1528487634 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | JEFFREY DHARMAWAN Dentist 909-825-1155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 33276) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-04-16 |