| NPI | 1588969547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY DENNIS CARLSON Managing Partner 760-630-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 34679) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 48905) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |