| NPI | 1659397206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE H FORD Secretaru 714-842-7431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 28714) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 28151) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-08-22 |