| NPI | 1730484320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE A. GOUVION Partner 949-733-1860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 19346) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51070) |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2011-01-13 |