| NPI | 1700159548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE B CHISHOLM President 760-779-9559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA G81937) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G81937) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |