| NPI | 1659418184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITA LOUISE BACON Receptionist Ins Biller 951-687-6040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 21975) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-08-22 |