| NPI | 1609243955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK MACKELPRANG Member 310-666-6438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AZ D009229) |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2015-08-21 |