| NPI | 1861874463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY ALLEN HURT Owner/Dentist 760-734-4311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 122300000X) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA 302F00000X) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2015-06-19 |