| NPI | 1548757347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKKI OTKOSOVA Office Manager 424-901-0701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA B54586) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2018-04-17 |