| NPI | 1679861603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMAN SHAMUELOV President/Director 619-504-4450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010277) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2011-07-11 |