| NPI | 1710548375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JOHNSON President 619-339-0760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2019-06-25 |