| NPI | 1790953859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY CLIBON President 760-245-8616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 44580) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2008-02-12 |