| NPI | 1730489014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE A TANABE President 562-698-0387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 39716) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CA 39716) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2017-12-26 |