NPI | 1588715031 |
---|---|
Former Legal Business Name | SOUTHLAND DENTAL GROUP ANTOINE SOURIALLE DDS |
Entity Type | Organization |
Authorized Contact | ANTOINE O SOURIALLE Owner 909-881-0645 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 44093) |
Enumeration Date | 2007-01-12 |
Last Update Date | 2020-08-22 |