| NPI | 1669826897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN ROY COVERT DODDS Owner/President 562-439-0754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CA 64207) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: CA 64202) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2016-04-13 |