| NPI | 1710074513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL A. BUSTAMANTE President 310-473-5559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 29218) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |