| NPI | 1831103175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JACOBSEN President 760-951-7752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 30185) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2020-08-22 |