| NPI | 1700978780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROCHELLE BACHE Office Manager 310-794-5750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 2024) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 2021) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 2021) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 2029) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 2026) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 2023) | |
| 124Q00000X Dental Hygienist (Licence: CA 2021) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |