| 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 |