| NPI | 1780247155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALIEKA JOHNSON Owner President 619-518-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| 261QH0100X Clinic/Center Health Service | |
| Enumeration Date | 2019-04-21 |
| Last Update Date | 2019-04-21 |