| NPI | 1669181178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS GONZALES Authorized Official 626-872-6352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2022-11-23 |