| NPI | 1538662036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILES MADISON Owner 310-553-2940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 37446) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2024-05-21 |