| NPI | 1780194985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRHAMID SALEK President 626-644-8618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE60319906) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CA 64405) |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2017-10-03 |