| NPI | 1811435092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON BRADLEY Insurance Coordinator 626-795-5978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 58043) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 55726) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |