| NPI | 1780179176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN BAE CEO 424-256-3967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 100794) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2024-07-30 |