| NPI | 1710289947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAFAELA DELARA Administrator 909-874-0323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 48644) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 57581) |
| 1223G0001X Dentist General Practice (Licence: CA 57930) | |
| 1223G0001X Dentist General Practice (Licence: CA 46985) | |
| 1223G0001X Dentist General Practice (Licence: CA 59318) | |
| 1223G0001X Dentist General Practice (Licence: CA 58057) | |
| 1223G0001X Dentist General Practice (Licence: CA 53832) | |
| 1223P0300X Dentist Periodontics (Licence: CA 38226) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 24358) | |
| 124Q00000X Dental Hygienist (Licence: CA 25296) | |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2010-11-19 |