| NPI | 1750054490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIGUEL REYES Q/A Contracts And Compliance Manage 310-409-4225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-07-28 |