| NPI | 1619859659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON WILSON Owner 310-600-8090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2025-07-22 |
| Last Update Date | 2025-07-28 |