| NPI | 1801913157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VLADIMIR POLYAKOV Owner 310-772-0700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 37480) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2014-09-15 |