| NPI | 1679741367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE BAK MORANDA Owner 760-321-8003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 48701) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2009-12-30 |