| NPI | 1578730628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL R JOHNSON CFO 909-621-6002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA D36088) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA D37238) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-05-08 |