| NPI | 1669833810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZADEH MARY AFZALI President 909-881-3336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 55014) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64657) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2016-03-16 |