| NPI | 1659571255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE LABOUNTY Dentist 310-303-7930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 48627) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2007-07-20 |