| NPI | 1730696519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAHER LABIB BARSOUM Chief Executive Officer 909-902-1708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 44145) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 57231) |
| 1223P0300X Dentist, Periodontics (Licence: CA 64229) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 64108) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 61000) | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2018-01-03 |