| NPI | 1740766146 |
|---|---|
| Doing Business As | CHILDRENS DENTAL FUNZONE |
| Entity Type | Organization |
| Authorized Contact | FARIBORZ RODEF President 626-412-0200 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 38356) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64776) |
| 122300000X Dentist (Licence: CA 56506) | |
| 122300000X Dentist (Licence: CA 58304) | |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2019-10-14 |