| NPI | 1801221882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT HENRY MINER Owner / President 760-420-6775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CA 60272) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2013-09-09 |