| NPI | 1699863654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY P YOUNG President Owner 909-861-2661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 31170) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 32662) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2012-06-12 |