| NPI | 1588104038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN HAYNIE President/CEO 619-280-7866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 62780) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2017-03-02 |