| NPI | 1669869087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL FULBRIGHT President/Owner 310-316-4477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 47892) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2015-10-14 |