| NPI | 1750575403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE LUIS GERONIMO Dentist 714-817-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 47897) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-09-05 |