| NPI | 1710164108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALYA SHAGRAMANOVA Owner/President 818-653-7778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 54204) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54204) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2008-01-28 |