| NPI | 1639547698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAISY GAGUI Om 818-703-7733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 35503) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 35503) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |