NPI | 1588828636 |
---|---|
Entity Type | Organization |
Authorized Contact | GARY R CROCKETT Owner 562-920-8324 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 20092) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 50687) |
Enumeration Date | 2008-07-17 |
Last Update Date | 2008-07-17 |