| NPI | 1639661341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY PETERSON Owner 714-672-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 57102) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2018-05-30 |