| NPI | 1598013039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHADI K. KHASATI Managing Dentist 951-302-6222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 504-78) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 46741) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |