| NPI | 1689635708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE WESTON MADDOX President 949-548-5029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 25741) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2013-09-23 |