| NPI | 1780053280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA RAE KRONQUIST President 714-547-6671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64750) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-07-23 |