| NPI | 1750773776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL HENRIOD Business Manager 951-698-4426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 39843) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CA 55124) |
| 1223P0700X Dentist Prosthodontics (Licence: CA 39843) | |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2023-01-09 |