| NPI | 1841892148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG THIEDE Office Manager 714-730-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2023-02-24 |