| NPI | 1770779852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMERA JOYCE RIVERS Office Manager 310-677-1565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 36613) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2007-09-21 |