| NPI | 1598373292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AN VAN NGUYEN CEO 760-865-0544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223E0200X Dentist, Endodontics | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 1223G0001X Dentist, General Practice | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2020-07-19 |
| Last Update Date | 2020-07-27 |