| NPI | 1710155973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE JOHNSON MASTROVICH Business Manager 760-741-6650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 26090) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2008-02-11 |