| NPI | 1790864254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENT W WILSON President 626-441-1167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 25654) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2020-08-22 |