| NPI | 1770762965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BLAKE Dental Director 562-933-3141 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA D36731) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA D36731) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CA D36731) | |
| 126800000X Dental Assistant (Licence: CA D36731) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2007-10-24 |