| NPI | 1700296605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE S. DODGE Owner 818-846-9041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 28436) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 29485) |
| 1223G0001X Dentist, General Practice (Licence: CA 41791) | |
| 1223G0001X Dentist, General Practice (Licence: CA 45014) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2014-04-30 |