| NPI | 1619069929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE M TANAKA Owner 619-420-8696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 39210) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 40575) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |