| NPI | 1861979544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT D POWELL Managing Member 559-299-3949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 56148) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 101165) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2018-07-25 |