| NPI | 1790421725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIKLAT ISSA Dentist 562-425-3311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-05-11 |