| NPI | 1790433001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIRISH MAKAN Clinical Director 310-872-8681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2022-10-26 |