| NPI | 1760861447 |
|---|---|
| Doing Business As | SPARKS MARINA DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ALI SHAHRESTANI Credentialing Administrator 714-845-8704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |