| NPI | 1689049892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOUDABEH SHARAFI Dentist 858-259-5527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 52929) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 52929) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 52929) | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |