| NPI | 1801511753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY POOLE Orthodontist 805-922-4778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2022-10-04 |