| NPI | 1770646317 |
|---|---|
| Doing Business As | SHADOWRIDGE AND POMERADO ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | JERROLD ALAN HENNES Orthodontist 760-598-1707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DI34494) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-08-22 |