| NPI | 1780051367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW KIKUCHI Sole Member 702-343-4720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: NV S2-138) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2019-07-19 |