| NPI | 1629124128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEDERSEN JOHN Owner 949-364-1171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-09-13 |