| NPI | 1558791079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA ZAK Dentist/Owner/CEO 310-706-5273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 122300000X Dentist |
| 1223E0200X Dentist Endodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2013-11-19 |