| NPI | 1790273829 |
|---|---|
| Doing Business As | 17TH STREET MODERN DENTISTRY DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | CLINT WALKER Owner 714-224-0480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2022-05-11 |