| NPI | 1669239612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA PETERSON Credentialing Coordinator 951-833-2740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2024-03-05 |