| NPI | 1760785422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM CLARK Owner 949-202-4420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 55257) |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2011-09-23 |