| NPI | 1588209712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENATA CARVALHO DA FONSECA President 310-463-3294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| 1223G0001X Dentist, General Practice | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2019-11-12 |